Anal Fissure and Burning Sensation in the Anal Region: Causes, Diagnosis, and Evidence-Based Treatment

By Dr. Karan R. Rawat – Gastrointestinal Surgeon & Proctology Specialist, Agra

Introduction

Burning sensation and pain in the anal region is a common but often misunderstood complaint. While anal fissure is one of the most frequent causes, not all anal burning is due to fissure alone. Conditions such as perianal fungal infection, dermatitis, hemorrhoids, and chronic irritation can present with similar symptoms.

Accurate diagnosis is essential, as mistreatment or self-medication often worsens the condition.

What Is an Anal Fissure?

An anal fissure is a small tear or crack in the lining of the anal canal, usually caused by trauma during passage of hard stools.

Common Causes of Anal Fissure

  • Chronic constipation

  • Hard or bulky stools

  • Repeated straining

  • Prolonged diarrhea

  • Spasm of anal sphincter muscles

Symptoms of Anal Fissure

  • Sharp cutting pain during or after defecation

  • Burning sensation around the anus

  • Bright red blood on toilet paper

  • Fear of passing stools

  • Chronic itching or irritation (in long-standing cases)

Burning Sensation in Anal Region – Important Differential Causes

Not every patient with anal burning has a fissure. Other causes must be ruled out.

1. Perianal Fungal Infection (Perianal Candidiasis / Tinea)

A very common but underdiagnosed cause of anal burning.

Symptoms

  • Intense burning and itching

  • Redness and macerated skin around anus

  • Moist or whitish discharge

  • Worsening after sweating

  • Minimal pain during stool passage (unlike fissure)

Risk Factors

  • Diabetes

  • Obesity

  • Excessive sweating

  • Prolonged use of steroid creams

  • Poor hygiene or over-washing

⚠️ Misuse of combination steroid creams significantly worsens fungal infections.

2. Hemorrhoids (Piles)

  • Burning and discomfort after stools

  • Mucus discharge

  • Bleeding without severe pain

3. Contact Dermatitis / Allergic Reaction

  • Reaction to soaps, wipes, perfumes

  • Burning and redness without internal pain

4. Chronic Moisture and Poor Anal Hygiene

  • Excess sweating

  • Improper cleaning

  • Prolonged sitting

5. Anal Fistula (Early Stage)

  • Burning with intermittent discharge

  • Persistent irritation

Key Clinical Differences

Feature Anal Fissure Fungal Infection
Pain during stools Severe Mild or absent
Burning After stools Constant
Bleeding Common Rare
Itching Occasional Severe
Skin changes Tear inside Red, wet skin outside

Diagnosis

  • Detailed clinical examination

  • Gentle local inspection

  • No aggressive instrumentation in acute pain

  • Blood sugar testing if fungal infection suspected

Treatment Approach

Treatment must be cause-specific.

Treatment of Anal Fissure

  • Stool softeners

  • High-fiber diet

  • Sitz bath

  • Local muscle relaxant ointments

  • Botox injection (selected cases)

  • Laser fissure treatment for chronic fissures

Treatment of Perianal Fungal Infection

  • Strict avoidance of steroid-mixed creams

  • Antifungal topical medications

  • Oral antifungal therapy (if severe)

  • Keeping area dry

  • Control of diabetes

Why Correct Diagnosis Matters

Using fissure creams on fungal infection—or steroid creams without diagnosis—leads to:

  • Worsening symptoms

  • Chronic skin damage

  • Delayed healing

  • Recurrent disease

Why Consult Dr. Karan R. Rawat – Fissure & Proctology Specialist in Agra

  • Expertise in anorectal disorders

  • Accurate diagnosis before treatment

  • Advanced laser treatment for fissure

  • Ethical, evidence-based care

  • Trusted by patients across Agra and nearby regions

Frequently Asked Questions

Q. Can fissure and fungal infection occur together?
Yes. Chronic fissure can coexist with fungal infection and both must be treated.

Q. Is burning always fissure?
No. Fungal infection is a very common cause.

Q. Are OTC creams safe?
No. Many contain steroids that worsen infection.

Conclusion

Burning in the anal region should never be treated blindly. Anal fissure and perianal fungal infection require completely different treatments, and accurate diagnosis is the key to permanent relief.

“In proctology, correct diagnosis is more important than powerful medicine.”
— Dr. Karan R. Rawat

Author

Dr. Karan R. Rawat
Gastrointestinal Surgeon & Proctologist
Safe Gastro & Surgery Center, Agra